Frozen shoulder, medically termed adhesive capsulitis, is a condition where the joint capsule surrounding the shoulder thickens and tightens, severely restricting the ability to move the arm. While the symptoms are alarming, surgery is generally not the typical course of action for this condition.
Understanding Adhesive Capsulitis
Adhesive capsulitis follows a predictable timeline, progressing through distinct stages. The initial phase is the Freezing stage, where pain increases and the shoulder’s range of motion slowly decreases. This stage can last two to nine months as inflammation causes the joint capsule to become progressively stiff.
The second phase is the Frozen stage, in which pain frequently stabilizes or lessens, but stiffness becomes the dominant symptom. Movement is severely restricted, impacting daily tasks. This stage typically persists for four to twelve months before the final phase begins.
The last phase is the Thawing stage, characterized by a gradual, spontaneous improvement in mobility and a reduction in stiffness and pain. The entire natural course of adhesive capsulitis is self-limiting, meaning the condition will resolve on its own. This process can take a significant amount of time, often ranging from one to three years.
The Primary Non-Surgical Approach
Because the condition is self-limiting, the majority of patients successfully manage their symptoms and regain function without an operation. Conservative treatment is the established first-line approach, focusing on managing pain and maintaining mobility while the condition runs its course. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often recommended to reduce pain and inflammation, particularly during the initial Freezing stage.
To provide targeted relief during the painful Freezing phase, a doctor may administer a corticosteroid injection directly into the shoulder joint. This potent anti-inflammatory medication significantly decreases pain, allowing the patient to more effectively participate in physical therapy.
Physical therapy (PT) is a cornerstone of non-surgical management, although its goal shifts depending on the stage. During the painful Freezing stage, PT is gentle, focusing primarily on pain management and preventing further loss of motion. As the condition moves into the Frozen and Thawing stages, the focus shifts to range-of-motion exercises designed to stretch the tightened joint capsule.
A therapist guides patients through specific stretching protocols to gradually restore flexibility and movement. Another non-surgical option is hydrodilatation, which involves injecting a large volume of sterile fluid into the joint capsule to stretch and expand it. This procedure often provides quicker relief of stiffness for some patients.
Criteria for Considering Surgical Intervention
Surgery is reserved for a small percentage of patients and is considered a last resort when conservative treatments have failed to provide meaningful improvement. The primary indication for surgical intervention is a lack of progress after a prolonged period of structured non-operative management. This typically means a patient has endured severe stiffness and pain, despite consistent physical therapy and injections, for six to nine months.
The decision to operate occurs when the patient’s severe disability significantly impacts their quality of life. The goal of surgery is not to cure the condition, but rather to accelerate the Thawing phase and restore functional range of motion more quickly than the natural progression. Patients with underlying conditions like diabetes may require surgical intervention more frequently.
Overview of Surgical Procedures and Recovery
Once the criteria for operative intervention are met, there are two primary surgical options. The first is Manipulation Under Anesthesia (MUA), where the patient is placed under general anesthesia, and the surgeon forcefully moves the shoulder through its full range of motion. This manual manipulation causes the scarred, thickened joint capsule to stretch or tear, immediately breaking up the adhesions that restrict movement.
The second option is an Arthroscopic Capsular Release, a minimally invasive procedure using small incisions to insert a camera and instruments. The surgeon uses these instruments to carefully cut away the tight, thickened portions of the joint capsule, restoring space and mobility to the joint. Both MUA and Arthroscopic Capsular Release are effective at increasing range of motion, and they are sometimes performed in combination.
Regardless of the procedure chosen, the operation is only the first step in the recovery process. Surgical intervention must be followed immediately by intensive physical therapy to maintain the range of motion gained during the procedure. This rehabilitation is necessary for preventing the shoulder from refreezing and ensuring a successful long-term outcome.